Provider Demographics
NPI:1164020749
Name:NORTH DAKOTA ASSISTIVE
Entity Type:Organization
Organization Name:NORTH DAKOTA ASSISTIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELLINGSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-365-4728
Mailing Address - Street 1:3240 15TH ST S STE B
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-6188
Mailing Address - Country:US
Mailing Address - Phone:701-365-4728
Mailing Address - Fax:701-365-6242
Practice Address - Street 1:3240 15TH ST S STE B
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-6188
Practice Address - Country:US
Practice Address - Phone:701-365-4728
Practice Address - Fax:701-365-6242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care